<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_id" data-rule="required" data-source="order/index" class="form-control selectpage" name="row[order_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Redeem_code')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-redeem_code" data-rule="required" class="form-control" name="row[redeem_code]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Verifier_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-verifier_id" data-rule="required" data-source="verifier/index" class="form-control selectpage" name="row[verifier_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Verifier_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-verifier_name" class="form-control" name="row[verifier_name]" type="text">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
